LUGPA 2026 Global Prostate Cancer Congress Enduring Program-Session 5

Video Transcription

Video Summary

The transcript captures a morning session at a urology/prostate cancer conference focused on screening “myths,” emerging pathology tools, and genomics-driven therapy in advanced disease.<br /><br />Dr. Egner opens by emphasizing that prostate cancer screening is valuable when done thoughtfully, but current PSA screening patterns are poorly aligned with benefit (older men screened more than younger). He debunks common misconceptions: PSA does not meaningfully change after DRE in most men, cycling does not elevate PSA, ejaculation causes only a brief PSA rise, and empiric antibiotics for an elevated PSA without infection do not help. He advocates individualized screening intervals using baseline/age-specific PSA to risk-stratify (often extending to 4–5 years or stopping in low-risk older men). For an elevated PSA, he recommends repeating the test before reflex ancillary testing. He reviews secondary biomarkers (no single “best” test), highlights the utility of free PSA, and notes PSA density is a continuous risk measure. PSA velocity adds little beyond other factors, and testosterone supplementation appears not to increase prostate cancer risk over several years.<br /><br />Dr. Cole discusses pathology innovations: metabolomics-based scoring to predict adverse pathology, and how AI/digital pathology can reduce inter-observer variability, detect neuroendocrine differentiation, and improve risk stratification. He describes emerging 3D tissue imaging that could analyze entire biopsy cores without exhausting tissue, potentially guiding who needs deeper sequencing.<br /><br />Dr. Morgan reviews ASCO-aligned guidance for germline and somatic NGS testing in metastatic prostate cancer to enable biomarker-directed therapies (notably PARP inhibitors for BRCA/HRR alterations and immunotherapy). He summarizes key PARP inhibitor trials, recent movement into metastatic castration-sensitive disease (especially BRCA2), and notes many prognostic biomarkers remain minimally actionable. The session ends with discussion on when to test, retesting on progression, and the need for practical clinical pathways. An abstract then presents phase 1 randomized data suggesting the EZH2 inhibitor nevrametastat plus enzalutamide improves radiographic PFS vs enzalutamide alone, with better tolerability when taken with food at a lower dose, and phase 3 trials underway.

Keywords

prostate cancer screening

PSA testing

screening myths

free PSA

PSA density

digital pathology AI

3D tissue imaging

germline and somatic NGS

PARP inhibitors BRCA HRR

EZH2 inhibitor nevrametastat enzalutamide